The Future of Community Health Services

The Department of Health requires primary care trusts (PCTs) to lay out a strategic vision and organisational options for the community health services that they currently manage. This provides PCTs with an opportunity to address many years of neglect in these services and to prepare for the growing health care needs of a population that is ageing and has rising rates of chronic disease.

Our report Shaping PCT Provider Services: The future for community health, published in April 2009, draws on a range of evidence about community services and health care service development. It aims to help PCTs to develop a service and organisational strategy that addresses key performance issues as well as to configure services to meet the changing needs of their local population.

Addressing performance issues

The evidence suggests that community health services, particularly community nursing services, urgently need to address a number of performance issues. There are opportunities to enhance the quality of services if they:

• clarify roles and responsibilities
• introduce more systematic approaches to caseload management
• move towards a service that is driven by needs not demand.

If some community services are to provide a genuine alternative to hospital care they need to be able to provide 24/7 support, with close working between all those offering support in the out-of-hours period.

Successful reconfiguration

The report suggests possible reasons why previous attempts to locate community health service provision better within the health care system have failed:

• each reorganisation has focused on structural change and not challenged the way in which services are delivered or staff work
• services have remained separate from primary care despite the importance of close working relationships
• aside from the attempts to reorganise, community health services have not been the focus of national or local attention and have struggled to attract investment or effective leadership.

Better integrated care

The experience of integrated care models reinforces a number of these messages and suggests that if primary care trusts wish to deliver more patient-focused and integrated care through their new community services structures, they need to:

• focus on process as much as on structure
• take account of the dynamics of new ways of working
• focus on the patients
• actively engage GPs to ensure strong co-ordination of  primary and community services.

Conclusion

In reviewing options for reconfiguration, our report suggests that there is no single ‘right’ way of working; different solutions will suit different circumstances. The use of outcome measures, and contracting with networks of providers for more integrated models of care can help PCTs to overcome inherent weaknesses in any organisational solution.